WHO says a lot needs to be done by the countries to combat antibiotic resistance

"While there is a lot to be encouraged by, much more work needs to be done to combat one of the most serious global health threats of our time." - Dr Keiji Fukuda, WHO's Assistant Director-General for Health Security. Dr. Keiji Fukuda also added that antibiotic resistance is the single greatest challenge in infectious diseases.

A survey was completed by 133 countries in 2013 and 2014 which captured the individual Government's own assessment of their responses to antibiotic resistance issues especially to blood borne infections, tuberculosis and HIV related infections. The survey revealed an appalling truth that only 34 out of 133 participating in the survey had any national plans to combat antibiotic resistance to antibiotic agents.

The exact situation might be far worser considering only 8 nations of the 47 member nations participated in the survey from the African Region. The issues of antibiotic resistance is rampant in African region. 

The encouraging aspect of South East Asian region was that all 11 member nations participated in the survey of which 5 out of 11 nations had a national plan to combat antimicrobial resistance. 

One more challenge that was revealed was that health workers comply poorly with prescribing standards and guidelines.

"Sequential antibiotics" or "Antibiotic Switching" may help avoid antibiotic resistance

Contributed by Dr. Akilesh Ramasamy & Dr. A. J. Tamhankar

Sequential use of antibiotics could have synergistic effect to avoid development of antibiotic resistance or even combat already resistant bacteria. While the use of combination of antibiotics has always been used for their synergistic effect, the use of sequential use of synergistic antibiotics is a new approach by Fuentes-Hernandez et al.(1) The first antibiotic sensitises the organism and the second antibiotic delivers the killing shot. While premature exhilaration on this finding should be limited as this study has found only about 6 sequences which have been found to be effective after trying about 139 different sequences. The study is in it's infancy stage but gives us a new approach to dealing with antibiotic resistance as the technique succeeded in clearing bacteria which had partial resistance to both the antibiotics. 

The results must be viewed with caution as the study has been done in-vitro and it is a known fact that bacteria could behave differently when inside the host. Moreover, the correct sequence and the doses could be important. In that scenario, the use of antibiotics at the exact dose and at specific exact times might be important for the sequential treatment to succeed in humans. The practical implications are numerous as in an already overloaded healthcare setting, there is a high chance that a particular dose might be missed, delayed or given early thus thwarting the entire exercise. So, new formulations or techniques of drug delivery agents might come up which release the particular dose of antibiotic at particular sequence and time. These developments are possible if the sequential antibiotic treatment is found successful in humans. In addition, it also gives hope to the old antibiotics which have been discarded due to development of almost universal resistance to them.

Source:

1: Fuentes-Hernandez A, Plucain J, Gori F, Pena-Miller R, Reding C, Jansen G, Schulenburg H, Gudelj I, Beardmore R. Using a sequential regimen to eliminate bacteria at sublethal antibiotic dosages. PLoS Biol. 2015 Apr 8;13(4):e1002104. doi: 10.1371/journal.pbio.1002104. eCollection 2015 Apr. PubMed. PMID: 25853342. http://www.ncbi.nlm.nih.gov/pubmed/25853342